<?php
$form = $this->beginWidget('bootstrap.widgets.TbActiveForm', array(
    'id' => 'horizontalForm',
    'type' => 'horizontal',
    'enableAjaxValidation' => false,
//    'action'=>Yii::app()->createUrl('');
        ));
?>
    

        <?php echo $form->errorSummary($model); ?>
<br>
<br>
        
        <div class="alert alert-success">B. Pemilik/Pengelola </div>
        
                <div class="control-group ">
            <label class="control-label" for="TestForm_textField">Nomor Bukti Diri </label>
            <div class="controls">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
        
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" >Nama Lengkap </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label" style="width:120px; ">Alamat Wajib Pajak </label>
                <input type="text" class="span4" readonly >
            </div>
        </div>

                <div class="control-group ">
            <label class="control-label" >Kecematan </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label" style="width:120px; ">Kelurahan/Desa </label>
                <input type="text" class="span4" readonly >
            </div>
        </div>
        
                <div class="control-group ">
            <label class="control-label" >RT </label>
            <div class="controls">
                <input type="text" class="span1" style="width:20px; " readonly >
                
                RW 
                <input type="text" class="span1" style="width:20px;" readonly >
                <label class="control-label">Kode Pos </label>
                <input type="text" class="span2"  readonly >
            </div>
        </div>

             <div class="control-group ">
            <label class="control-label" >Kabupaten </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label">Kewarganegaraan </label>
                <input type="text" class="span2" readonly >
            </div>
        </div>
        
                        <div class="control-group ">
            <label class="control-label" >Telepon </label>
            <div class="controls">
                <input type="text" class="span2" >
                
            </div>
        </div>
        
        <div class="control-group ">
            <label class="control-label" >Jabatan </label>
            <div class="controls">
                <input type="text" class="span3" >        
            </div>
        </div>
        

<div class="alert alert-success">C. Pencatatan</div>
        
<div class="control-group ">
            <label class="control-label">Cara Hitung</label>
            <div class="controls">
                <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => 'Self Assessment (SA)',
            '1' => 'Office Assessment (OA)',
            
                ), array('class' => 'span1'));
        ?>

                <label class="control-label" >NPWPD</label>
                <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => 'P',
            '1' => 'I',
            '2' => 'R',
            
                ), array('class' => 'span1'));
        ?>
                <input type="text" class="span1" style="width: 20px;" >
                -
                <input type="text" class="span2" value="000005" >
                -
                <input type="text" class="span1" style="width: 20px;" value="01" >
                -
                <input type="text" class="span1" style="width: 40px;" >
            </div>
        </div>
        
<div class="control-group ">
            <label class="control-label" >Petugas </label>
            <div class="controls">
                <input type="text" class="span2" value="Dany Erlangga" >
            </div>
        </div>

<div class="control-group ">
            <label class="control-label" >NIP </label>
            <div class="controls">
                <input type="text" class="span3" value="123070123" >
            </div>
        </div>

<div class="alert alert-success">D. Pendataan</div>

<div class="control-group ">
            <label class="control-label" >Petugas </label>
            <div class="controls">
                <input type="text" class="span2" value="Dany Erlangga" >
            </div>
        </div>
<div class="control-group ">
            <label class="control-label" >NIP </label>
            <div class="controls">
                <input type="text" class="span3" value="123070123" >
            </div>
        </div>


<div class="control-group ">
            <label class="control-label" >Tanggal Pendataan </label>
            <div class="controls">
                <input type="text" class="span2"  >
            </div>
        </div>



       

        <div class="form-actions">
            <?php
    $this->widget('bootstrap.widgets.TbButton', array(
        'type' => 'primary',
        'label' => 'Cetak',
        'icon' => 'cetak',
        'url' => Yii::app()->createUrl("/PendaftaranDanPendataan/CetakKartuData/cetak"),
        'htmlOptions' => array(
            'style' => 'margin-left:5px',
        ),
    ));
    ?>
            <?php
            $this->widget('bootstrap.widgets.TbButton', array(
                'buttonType' => 'submit',
                'type' => 'primary',
                'label' => $model->isNewRecord ? 'Batal' : 'Reset',
            ));
            ?>

        </div>
    

<?php $this->endWidget(); ?>